早期胃癌と誤診した進行癌―早期癌と進行癌の相関

ADVANCED CANCERS MISTAKENLY DIAGNOSED AS EARLY GASTRIC CANCER

Ⅰ．はじめに

　私共のところでは毎年220例前後の胃癌の手術がある．

　昨年は237例の手術がおこなわれ，そのうち早期胃癌は粘膜内癌30例，粘膜下層癌31例合計61例であった．このほかに手術前には早期胃癌と診断されていたが，切除後の組織学的な検索により，癌が粘膜下層を越えているために進行癌とされた症例が9例あった．

　この9例を中心に，やや古い症例も加えてそれぞれの概略を提示しよう．

　現在，われわれは粘膜下層と固有筋層の境界を目印にして，胃壁における癌浸潤の純粋に形態学的な深さの判定のみで表在癌は早期癌，深達癌は進行癌と分類している．

　今回提示したような症例を記載するにあたって，附題として早期癌と進行癌の相関についても述べたい．

　The cases which had been diagnosed as early gastric cancer and was made sure as advanced cancer at the time of operation, were studied. Many cases were Ⅱc+Ⅲ and the cancer cell had penetrated submucosal layer at the ulcus scar. So these cases were diagnosed as advanced cancer. The cases of an elevated change with liver metastasis and a small cancer with less than 2cm in diameter reaching the subserous layer were also presented. Combined examinations of X-ray examination, gastro camera and fiberscope are necessary to know the depth of infiltration. In the terms “early cancer” and “advanced cancer” are included not only the degree of advancement or prognosis but also some time factor. Nowadays early cancer is defined as the cancer restricted as the cancer reacching beyond the submucosal layer. Relationship between the early cancer and the advanced cancer was studied from many aspects using the morphological standards mentioned above.